【摘要】 目的探讨老年肺栓塞的临床特点和诊断方法,减少误诊率和漏诊率。方法回顾性分析我院确诊的60例老年(≥65岁)肺栓塞的高危因素、临床表现和辅助检查结果。结果老年肺栓塞的危险因素为下肢静脉血栓(DVT,33.3%)、手术外伤(25.0%)、长期卧床(23.3%)。呼吸困难为最常见症状(80.0%),96.7%患者临床症状缺乏特异性。螺旋CT肺动脉造影(CTPA)结果显示老年患者肺栓塞部位主要为右下叶肺动脉(38.9%)、右肺动脉(35.2%)和左下叶肺动脉(29.6%),53.7%的患者为多支血管受累。核素肺通气/灌注扫描(V/Q扫描)的阳性率为73.9%,CTPA的阳性率为65.2%,43.5%的患者V/Q扫描和CTPA均为阳性,二者联用的检出率为95.7%。结论老年肺栓塞表现为多处、主要血管受累,以右肺动脉和双下叶肺动脉多见。提高老年肺栓塞的诊断水平,及时正确的诊断和治疗可改善预后,降低病死率。推荐联合使用V/Q扫描和CTPA检查。更多还原

【Abstract】 Objective To analyze the clinical characteristics and diagnostic method of pulmonary embolism in aging patients. Methods The risk factors, clinical presentations and results of ancillary examinations of 60 older patients(≥65 years old) were retrospectively analyzed. Results The main risk factors for Aged-PE were deep venous thrombosis(DVT,33.3%), operation and/or trauma(25.0%), and prolonged bed rest(23.3%). Dyspnea was the most frequent symptom(80.0%), but the majority(97%) had no specific symptoms.Helico-Computerized Tomography Pulmonary Arteriography(CTPA) showed that the main positions of Aged-PE were right inferior pulmonary artery(38.9%), right pulmonary artery(35.2%) and left inferior pulmonary artery(29.6%), 53.7% patients had several vessels involved. The positive rate of Ventilation-perfusion scintigraphy (V/Q scan) was 73.9%. The positive rate of CTPA was 65.2%. 43.5% patients had a V/Q scan and CTPA positivity. The detection rate of combined use of the two examinations was 95.7%. Conclusion Multi-vessels and one major vessel can be involved in most Aged-PE. The right pulmonary artery, right and left inferior pulmonary artery are the most frequently involved. It is necessary to improve the diagnosis of pulmonary embolism inaged-patients. Timely diagnosis and treatment can improve the outcome and reduce the mortality rate. The combined use of V/Q scan and CTPA is recommended.更多还原